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Monday, December 9, 2013
Knee Fusion or Above-the-Knee Amputation?
My husband had a knee replacement go bad because of necrosis from a blood thinner. The doctors have given him the option of a knee fusion or amputation above the knee. What should we choose?
There is no easy answer to this question.
On the one hand, if his foot, ankle and leg below that knee are fully functional, a knee fusion would preserve this function, but it would certainly necessitate that he walk with compensatory movements, which would be even more pronounced when trying to go up or down stairs as well as inclined or declined surfaces, since a fused knee of course doesn't bend. Besides a significantly changed and more laborious gait pattern, a fused knee would also create other difficulties such as making it difficult to sit in tight quarters such as in movie theaters, on airplanes, the back seat of a car, etc. If he has any problems with his hip on that side, with his lower back, or with his opposite leg, those conditions could become aggravated by the additional stresses resulting from this changed gait pattern.
On the other hand, amputation above the knee would allow him to have the option of a wide variety of prosthetic knee, ankle and foot components to maximize function (walking, sitting in tight quarters, etc.), but he of course wouldn't have sensation below the knee, nor active control over foot, ankle, nor knee movements.
He and you should carefully consider not only the brief comments above, but also, discuss additional pros and cons for each option at length with his surgeon. If at all possible, it would also be very useful if his physician can arrange for him to meet/talk with one or more patients who've undergone each of these surgical procedures to get their unique and personal perspectives.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University